Dr. Rajesh Nair

Ayurveda is one of the ancient branches of medicine, still flourishing effectively as all its principles are standing at par with modern science. The whole of Ayurveda is written in verses of Sanskrit, an ancient Indian language. Obesity has been long associated with metabolic disorders of varied attributes. Knowledge on obesity and its adverse impacts on human health date back as long as 5000 BC, where the first known references of the disease are found in the ancient classics of Ayurveda.

According to Ayurveda, the human body is composed of Tridoshas (three factors) viz, Vaata (the factor which maintains functionality, mobility, respiration and co-ordination), Pitha (that which maintains digestion and metabolism), Kapha (that which maintains cellular integrity). These three functional base units regulate all our physiological activities. The Tridoshas and obviously the human body itself are further composed of the Pancamahabhutas, viz Prithvi, Ap, Tejas, Vayu and Akasa, all of which represent fractions of the various elements and compounds found in our body. Ayurveda finds human body as a miniature of the entire universe. This was the crude form of metaphysics and biochemistry as was understood by eminent scholars of Ayurveda in those times. Though a crude form of the present known composition of the human body, the modern science can be well superimposed into the framework put forth by Ayurveda.

Ashtangahrdaya a classical treatise on Ayurveda states,

“Rogastu doshavaishamyam doshasamyamarogatha.”

Roga (disease) is a result of impairment of Doshas and if they are normal, the person is healthy. This simply means disease is an outcome of impaired body physiology. Though a statement in general, this applies equally well to all the metabolic disorders including obesity.

Obesity is known as Sthoulyatva in Ayurveda, a disease condition attributed to the excess of Kapha Dosha and Medas (the adipose tissue).

If we follow the daily regime as per Ashtangahrdaya, we can keep away almost all the non-communicable diseases particularly obesity. Ashtangahradaya’s chapter on Dinacharya (Daily Regime to be followed) clearly articulates the importance of regular exercise,

“Laghavam karmasamarthyam deepto agnirmedasa: kshaya:

vibhaktaghanagaatratvam vyayamadupajayate”

Lightness of body, efficiency in work, better digestion, control of obesity and a well contoured physique are achievable by regular exercise.

Unfortunately, we fail to exercise regularly in today’s busy schedule which our employment conditions demand. This is where the importance of medicines and therapeutic procedures to reverse the damages become necessary.

Another advice of Ashtangahrdaya is regarding food habits to be followed. It says “eat food that is good to you in a moderate quantity only when you are hungry enough”. Our eating habits have also changed a lot in course of time surrendering ourselves to oily snacks and such other unhealthy stuff known better as junk foods. At times, even if we want to avoid them, our situation might demand it.

What happens simply is that we take a lot of calories in excess which our body doesn’t actually demand and also fail to exercise regularly to utilize the excess energy. So our body converts the excessive fraction to biomolecules which can be stored for later utility. As such, fat in the form of fatty acids get deposited in the adipose tissue (Medas) and glucose gets converted to glycogen (which can be attributed to the Sleshmamsa or Kapha supporting the Mamsa Dhatu or muscle tissue) which is stored in the muscle tissues. Along with this anabolic process, catabolism also takes place as per varying body demands. Therefore, breakdown and transport of this stored biomolecules also happens, though at a lower rate than deposition takes place. Over a long period of time storage and transportation facilities attain saturation and proceed to exceed the threshold limit beyond which symptoms of metabolic disorders begin to appear. The triglycerides, LDL, VLDL, all being in high levels in circulation, have a tendency to get deposited while in circulation, at any point where there is thickening in the vessel walls (which might be due to ageing or metabolic stress itself) to form atherosclerosis or arteriosclerosis. Impaired metabolism of glucose adds to the problem and altogether this metabolic derangement poses risk of diabetes, hypertension, cardiovascular diseases, embolism, and even cerebrovascular accidents. Increased viscosity of Rakta (blood) due to higher concentration of molecules in transport also puts heavy load on the heart to pump with much higher force. Sclerosis of vessels raises the already higher peripheral resistance to further heights (Rakta Vriddhi). Body tries to lower the concentration of solutes in blood by enhanced glomerular filtration rate and urine output. But this only lowers the fluid volume and often sodium is retained which can further add to elevated blood pressure levels. The adipose tissue synthesise angiotensinogen which gets converted to angiotensin I and angiotensin II catalysed by angiotensin converting enzyme augmented by rennin. Angiotensin increases tubular resorption of sodium and synthesis of aldosterone, the hormone responsible for sodium retension.

Caraka, another great scholar of Ayurveda, explains in his classical treatise Caraka Samhita this relation beautifully in a single verse,

“Medovahaanaam srotasaam vrkkou moolam vapavahanam ca”

Metabolism of fat is based in the adipose tissue and is linked to the functions of both the kidneys.

Again according to Caraka Samhita Raktavaha Srotas is described as being related to liver and spleen,

“Shonitavahaanaam srotasaam yakrnmoolam pleeha ca”

Liver undoubtedly plays the major role in the metabolism of glucose and fat. It converts glucose to glycogen and synthesises and redistributes lipids such as triglycerides.

And the reasons as explained by Caraka for the derangement of normal physiology of these two srotases are very much similar and interrelated.

“Vidaaheenyannapaanaani snigdhoshnaani dravaani ca

raktavaaheeni dushyanti bhajataam ca aatapaanalou”

Raktavaha srotas gets deranged by the excessive intake of irritant, oily, hot food and fluids along with prolonged exposure to sun or fire. Here Caraka gives stress on how dehydration adds up to haemoconcentration which further makes fat metabolism difficult and results in greater viscosity of blood ending up in disorders of the cardiovascular system.

Similarly are explained the causes for derangement of Medovaha Srotas,

“Avyaayaamaat divaasvapnaat medyaanaam ca atibhakshanaat

medovaaheeni dushyanti vaarunyascha atisevanaat”

Lack of regular exercise, day sleep, excessive fatty diet and excessive use of alcohol cause deranged physiology of Medovaha Srotas.

Caraka’s definition of Sthoulyatva reads,

“Medo maamsa ativrddhatvaat cala sphik udara sthana:

ayathopachayotsaaho naro ati sthoola ucyate”

One who is having excessive adiposity, bulky and flaccid musculature which causes him to have parts of body loosely shaking while he is walking, besides weak metabolism and low enthusiasm is known as Sthoola.

Madhavacarya adds that this Medovaha Srotas getting impaired can cause Vata Prakopa (deranged physiological activity of Vata Dosha). Vata being that which is responsible for all kind of kinetics of the body affects blood circulation and results in hypertension.

Thus several mechanisms add up to the predisposition of hypertension and such other lifestyle induced non-communicable diseases in an obese individual. In a long run, it further damages blood vessels, heart, liver and kidneys leading to further complications. The damaged tissues suffer much more oxidative stress due to decreased efficiency of free radical scavenging. Thus signs of ageing also set in much earlier than what is expected for a non-obese individual.

In the line of treatment advised for Prameha (Diabetes mellitus), Caraka indicates Shodhana (Purification and Detoxification) as the treatment of choice for Sthula Pramehi (Diabetic patients in whom obesity is the primary cause). This also takes into account the primary problem of obesity as well. And managing obesity can reverse all other disease conditions associated with it.

So the treatment of any condition related to obesity should primarily aim at the management of obesity itself. Regular exercise, balanced diet, proper recreation, sound sleep and overall reduction in physical and mental stress are all the more important in checking the problem of morbid obesity, which is one of the rising health concerns worldwide.

And in severely demanding conditions, it may be so required to augment and catalyse the process of weight reduction using suitable medications. Ayurveda has a major role in this direction owing to its least adverse effects in addition to proven efficacy of its time tested formulas. Ayurveda has a holistic approach against obesity. Besides medicines, a balanced diet, regular exercise and psychological well being are the keys to address obesity at its root cause. Ayurveda encompasses all these aspects very well. An Ayurvedic way of life can make sure that you keep away from obesity and all its complications including hypertension. Ayurvedic medicines taken under expert guidance can further help you achieve the aim.